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is it true?

Discussion in 'Pathology' started by jewright311md, Jan 4, 2009.

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  1. jewright311md

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    I am considering Pathology but i just dont want to sit in a lab all day, also in what capacity to Pathologist serve as consultants to Physicians in the hospital, hows the patient interaction??????
     
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  3. yaah

    yaah Boring
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    I am not sure what you mean by, "Consultant in diagnosing patients." Do you mean do they call us up and say, "we're stumped, can you help us out?" No, that doesn't happen. They send us biopsies and ask us to interpret rare or confusing lab tests though. Most pathologists don't sit in a lab all day, but we do a lot of sitting in offices or multiheaded microscope rooms looking at slides. See the pathology forum - there are some FAQ about what a pathologist actually does. If you have questions go and talk to a pathologist at your med school or ask if you can sit on on signouts for a couple of days, that will give you much more perspective.
     
  4. jewright311md

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    is there any specialty in which "they" call us up and say, "we're stumped, can you help us out?"
     
  5. yaah

    yaah Boring
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    Yes - every subspecialty field within medicine. If you are stumped about a cardiac issue, you call a cardiologist. A kidney issue, you call a nephrologist. A cancer, you call an oncologist. There are no super diagnosticians who answer the bell on anyone's dilemmas though. Nothing like House exists in real life, if that's what you're asking. The medical profession as portrayed on House does not exist. It is farcical. It is not even close to reality. It is actually an abomination. I recommend you not watch it unless you just like watching Hugh Laurie criticize people.
     
  6. phospho

    phospho SDN Lifetime Donor
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    :laugh:
     
  7. Gene_

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    Become excellent at what you do, regardless of specialty. Your colleagues will seek out your opinion on their tough cases, which is essentially what you're talking about. This happens in pathology all the time. Another example, there is an internist where I went to med school that was so well regarded for thinking outside the box on tough cases that it was a legitimate order to write for a "Dr. X Consult."
     
  8. JPmamd09

    JPmamd09 Chillin
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    .As a fourth year student, here’s my $0.50 – you can take it or leave it.

    First, don’t obsess over what specialty you’re going to go into. You have a LONG time to decide. (I know, I’d have rolled my eyes too during first year at that.) It's a good idea to consider things that are important to you or that you enjoy, but to be completely honest it may be tough to really figure out what you enjoy until you're on the wards third and fourth year.

    If you need something to obsess about:

    1.
    Spend this time focusing on your first and second year courses. Doing well now keeps your options as wide open as possible. Learning the material well will help you for step 1 of boards

    2. On the topic of boards, if you need something to obsess about, start studying. U
    se review texts now to study for your classes. Buy practice questions if you must. Again, doing well on step 1 will keep lots of residency possibilities available to you.


    If you can’t deal with the suspense, consider shadowing physicians in all three specialties. Keep in mind you’ll have to do 3 years of internal medicine for rheum or ID. Honestly I don’t think shadowing will tell you much - you really have to deal with the day to day grind before you can find out if something is for you. As suggested, read the path FAQs for answers to some of your questions. Not to beat the dead horse, but I don’t think you’re going to find exactly what you’re looking for. It does sound like you’re describing House, and during third year you’ll find that real medicine is absolutely NOTHING like what you see on TV. Try to learn as much and enjoy as much from the first two years as you can – and I guess keep watching House as long as you can, you’ll find your free time will begin to shrink significantly over the next few years. Best of luck.

     
  9. HbyHA

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    so true...

    i actually experienced the "House effect" several years ago when I was in a urology clinic and a patient wanted to know why their test took so long, because on "House" it only takes 30 mins.

    thanks, House MD
     
  10. Sean2tall

    Sean2tall Pathology Resident
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    Yikes, abomination? I think that's a little strong. Sure it's inaccurate how they take a specimen from a patient, slap it on the stage of a microscope and pipette some liquid on it and say "It's CD68 positive!" But it's a freaking TV show. I find it more irritating how people get so outraged when their job is portrayed inaccurately on TV. You could say that it's screwing up the public perception of the field, but where does that end? No shows about cops, CSI, lawyers? Even being in jail is portrayed as glamorous.

    Sorry for this off topic rant, but this is one of those things that bugs me.

    I do feel like in pathology you get to "help" in a sense with difficult cases, as things that get to us are more likely to be unusual if they have progressed to tissue exam with no diagnosis, but it sounds like what you are looking for is interaction with patients and "on the ward" working with the clinicians. I think you will be dissatisfied if you chose pathology for that reason.
     
  11. yaah

    yaah Boring
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    It is an abomination. It might as well not even be about medicine. They might as well just create some sort of new career and have House have that as his profession. As I have said before, the fact that they take some liberties with medical practice and disease manifestations does not necessarily bother me - it is the fact that they deliberately do work to find out the real practice, incorporate part of it, but then change the critical step to something farcical. The CD68 thing is a nice example of it. If you're going to do that, then don't go through the trouble of telling people it's a CD68 stain and perform it using a procedure that does not exist. Just say it's a "special stain" and be done with it. Or make up a histiocyte stain and use that. I wouldn't have as much of a problem with it if they didn't go through so much trouble to get the terminology right, then **** on it and expect people to swallow it.

    I enjoy fictional stories. They are fun. But a lot of TV shows now are attempting to be fictionally realistic - they are altering reality to fit their fiction while still maintaining the illusion of reality. It would be like, on Miami Vice, if Crockett shows up with a new Ferrari and said he bought it on his cop salary. That doesn't work. If Crockett just magically shows up with a Ferrari and they don't explain it, that's not as much of a problem.
     
  12. digitlnoize

    digitlnoize Rock God
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    Agreed that TV is not real life. Having worked in a hospital, I (as a 1st year med student) at least know that much.

    That being said, although House's job and procedures aren't real, the diseases are...and the show does a fairly good job of presenting accurate sx of most of the diseases (at least the characteristic sx)...at least for my 1st year purposes.

    The animations are far better than any others available. I'm still waiting for someone to edit together a YouTube compilation of all of the House animations.

    Sorry to barge in, but just wanted to play devil's advocate. Also, I didn't know Hugh Laurie was British until SNL a month or so ago. He's quite good with the american accent.
     
  13. sohsie

    sohsie Member
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    House is absolutely an abomination.

    I watched one episode of it. It outdid in one hour the worst excesses of every ER episode put together.

    The episode I watched, female patient had an ectopic pregnancy in her colon. Surgeon removed it, but she still had symptoms (wont go into them). They review the tape of the surgery, see a tiny lesion on the OUTSIDE of the colon, decided its a "ganglioma" (whatever that is), and that its causing all the symptoms. Surgeon refuses to go back in, so they put a colonoscope in with a light bulb at the end, find the lesion (not sure how you see a serosal lesion on endoscopy), push the segment of colon up to the abdominal wall, make an incision through the skin and abdominal wall and take a biopsy.

    They read the biopsy themselves, not through a microscope, but through looking at one image on a computer screen. Diagnose amyloidosis immediately. Speculate as to the cause, decide maybe the patient has lymphoma.

    Show screen image to an ONCOLOGIST. Oncologist says "I see AN atypical cell (not multiple cells, but ONE cell), and since I'm an oncologist, I say its lymphoma" ?!?!?! Then he says "I bet you showed this to an immunologist who said its autoimmune". They respond affirmatively. Oncologist reiterates that whereas the immunologist always sees autoimmune disease, he sees lymphoma, and so he thinks its lymphoma?!?!?

    Based on this thorough pathologic examination to achieve a diagnosis of "lymphoma" with no subtype, team starts CHEMO! Patient gets better, House walks in, stabs patient in knee area with big needle, says "Its Leprosy, thats why she's a little better on chemo, but keep it up and she'll die", and walks away. Team walks away satisfied with the diagnosis.

    But hey, who needs a pathologist anyway.
     
  14. HbyHA

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    Sohsie-

    I tried several times to write a response summing up exactly what I think of House, and that was pretty much it, but you said it much better. i love it when they diagnose some kind of malignancy and say, "Chemo it is, or the patient dies"! Uhhhh want to get a little more specific on that chemo order? I tried to explain it for several minutes to my husband before dissolving into a fit of laughter at the ridiculous all. Seriously, you could take one of those "people" (fellows? junior attendings? people who are capped at one patient, for like 5 of them!?!) and replace our entire housestaff with maybe, 10 of them. would save a lot of money, in these bad economic times...
     
  15. sohsie

    sohsie Member
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    Thanks. I almost forgot the best part. The summation of the sequence of events.

    The crack House team put it together as follows: 1) Patient had dormant leprosy. 2) Patient gets pregnant 3) Pregnancy kicks in immune response 4) Immune response leads to amyloidosis 5) Amyloidosis (or the immune reponse, Im not sure) causes scarring of the Fallopian Tubes 6) Scarring of the Fallopian Tubes leads to the pregnancy becoming ectopic! FINI!

    Errrr, so the egg gets fertilized while making its way down the Fallopian Tube, and then it kicks off this chain of events that scars the tubes so quickly that the egg can't even make it to the uterus in time? Or did the egg reverse course after implantation and try to go back out the Fallopian Tube?

    Lesson to learn: Scrubs is still by far the most accurate medical show on TV.
     
  16. yaah

    yaah Boring
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    Personally, I lost it during one of the two episodes I watched (the other being the above-mentioned CD68 episode) when House's team performed an open lung biopsy, took the wedge of lung over to the 1960s microscope on the table in the corner of the OR, and looked at the lung there without doing anything to it. Then they did a "congo red stain" on that chunk of lung and diagnosed amyloidosis. I think they even mentioned "apple green" in there. WHAT A JOKE. Personally, I think it would be more amusing if they had House and his team forced to deal with normal hospital delays.

    1) Request biopsy from surgeons to determine what's wrong with the lungs
    2) Surgeons refuse because there are no solid indications, request that they actually get better radiology. Surgeons perform brief 2 minute consult with 30 second physical exam but leave a note in the chart that says biopsy is not indicated at this time and additional radiology would help.
    3) Radiologists perform additional scan, give a waffling differential diagnosis. House looks at scan himself and thinks he knows what it says. Radiologist tells him he is wrong and asks him who has more experience looking at scans. Radiologist notes an incidental 5 mm nodule in the liver which could be either hemangioma or scar or malignancy. Based on atypical lung findings, says it could be consistent with metastasis from a lung cancer.
    4) Armed with the differential diagnosis, House returns to surgeons, who agree to do a biopsy. But first they want a GI consult to evaluate the liver mass.
    5) Gi consult evaluates patient, says we can ignore the 5 mm mass for now and follow it, but this adds another couple of days.
    6) Surgeons agree to biopsy, but want to start with a bronch and trans bronch biopsy with cytology. This is non diagnostic. Specimens go to pathology where they are processed. More days of delay. Because infection is in the differential, House's team, the infectious disease team, and the surgeons all call up the pathologist individually to mention the fact that infection is in the differential. Even though the specimen doesn't show much in the way of inflammation, they all demand that special stains be done. Pathologist agrees so as not to waste more time arguing. Stains are negative.
    7) Infectious disease team mentions that since the patient spent 2 months the previous year in africa, it could be a strange virus. Could we send the tissue to a specialty lab for PCR? Pathologist says it is not indicated. Clinician send it anyway. More delay. Comes back negative.
    8) Surgeons agree to open biopsy. Send biopsy for frozen section which reveals nothing except some non-specific changes, then surgeons neglect to send a lot of additional tissue so diagnostic tissue is limited.
    9) Pathologist receives tissue, has trouble with it because most of the tissue was frozen. Sees something that could be amyloid, stains it with Congo Red. Stain results are equivocal. One pathologist down the hall thinks he sees some possible green birefringence. Another one says it isn't.
    10) House then orders 25 send out lab tests to random esoteric labs.
    11) Patient becomes anemic from blood draws, needs transfusion.
    12) Labs come back, one of the 25 esoteric tests is equivocal, other 24 are negative.
    13) Equivocal test is repeated
    14) Equivocal test is positive
    15) House consults multiple people to figure out whether the positive test could be do to the blood transfusion that the patient got in between lab draws.
    16) House makes diagnosis.
    17) Patient trips and falls on the way out smoke a cigarette, sues hospital.
     
  17. TypicalTuesday

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  18. HbyHA

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    what about:

    18) patient dies. autopsy team makes the correct diagnosis.

    just. a bit. too. late.
     
  19. mcfaddens

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    Probably not a great idea posting in a subspecialty forum as a 1st year med student about a medical television drama.
     
  20. digitlnoize

    digitlnoize Rock God
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    Why is that? Is it because Pathologists have more understanding of medical television dramas than other people? I don't recall that being part of medical training...

    Look, this is not exactly a "serious" discussion, and I the topic interests me, so I wanted to toss my 2 cents into the ring to play devil's advocate.

    It's really not that big a deal. Of course, you all know much more than this 1st year med student, but I'm 30 years old and I've been around the medical and entertainment block. I agree that Scrubs is the most accurate TV show (big deal).

    I simply wanted to point out that as 1st year student some of the animations on house are cool.

    I am terribly sorry for interrupting your important pathologist enclave. Forgive me, your highness. My impudence knows no bounds. :rolleyes:

    See?
     
  21. yaah

    yaah Boring
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    You're more than welcome to post here. I agree this is a silly thread.
     
  22. mcfaddens

    mcfaddens Member
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    WOW looks like my sentence hit a soft point, did i hurt your feelings?

    what is :rolleyes: ? Are you serious, do you have nothing to do with your time but watch TV and play on the internet? Get a life. you are 30 and in med school you have to grow up soon. fantasy time is over looser..hahahahaha
     
  23. yaah

    yaah Boring
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    OK, closing this one now. Play nice please.
     
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